Tex.
Human Resources Code Section 32.0291
Prepayment Reviews and Payment Holds
(a)
Notwithstanding any other law, the commission may:(1)
perform a prepayment review of a claim for reimbursement under the medical assistance program to determine whether the claim involves fraud or abuse; and(2)
as necessary to perform that review, withhold payment of the claim for not more than five working days without notice to the person submitting the claim.(b)
Subject to Section 531.102 (Office of Inspector General), Government Code, and notwithstanding any other law, the commission may impose a payment hold on future claims submitted by a provider.(b)
Subject to Sections 544.0104 (Employment of Medical Director) and 544.0105 (Employment of Dental Director) and Subchapter G, Chapter 544 (Fraud, Waste, Abuse, and Overcharges Relating to Health and Human Services), Government Code, and notwithstanding any other law, the commission may impose a payment hold on future claims submitted by a provider.(c)
A payment hold authorized by this section is governed by the requirements and procedures specified for a payment hold under Section 531.102 (Office of Inspector General), Government Code, including the notice requirements under Subsection (g) of that section.(c)
A payment hold authorized by this section is governed by the requirements and procedures specified for a payment hold under Sections 544.0104 (Employment of Medical Director) and 544.0105 (Employment of Dental Director) and Subchapter G, Chapter 544 (Fraud, Waste, Abuse, and Overcharges Relating to Health and Human Services), Government Code, including the notice requirements under Section 544.0302.(d)
Repealed by Acts 2013, 83rd Leg., R.S., Ch. 622, Sec. 6, eff. September 1, 2013.
Source:
Section 32.0291 — Prepayment Reviews and Payment Holds, https://statutes.capitol.texas.gov/Docs/HR/htm/HR.32.htm#32.0291
(accessed Jun. 5, 2024).